Information Collection

Government Service Information

IC 19619 under ICR 201801-1545-017 · OMB 1545-1919.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1919 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 12854 Government Service Information	Form
12854 GOVERNMENT SERVICE INFORMATION Form 12854 draft 2018.pdf	Form
letter.pdf sample Letter	IC Document

IC Title:

Government Service Information

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 26 CFR 315.801 26 CFR 315.802 26 CFR 531.202 26 CFR 531.203(c)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	12854	GOVERNMENT SERVICE INFORMATION	Form 12854 draft 2018.pdf		No		Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title: IRS 36.003, General Personnel and Payroll Records

FR Citation: 80 FR 54063

Number of Respondents: 24,813

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	24,813	24,813
Annual IC Time Burden (Hours)	6,203	6,203
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
sample Letter	letter.pdf	01/17/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.